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MEDICINA > Infecciosas > Flashcards

Infecciosas Flashcards

1
Q

What percentage of patients with a reported allergy will tolerate penicillin?

A

Approx. 85–90% of patients

This suggests that many patients may not have a true allergy.

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2
Q

What should be included in an allergy evaluation for penicillin?

A

An epicutaneous (prick) test and, if negative, an intradermal test

These tests help assess true penicillin allergy.

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3
Q

What qualifies a patient for desensitization to penicillin?

A

A possible history of an allergic reaction

This applies even if allergy evaluation is not possible.

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4
Q

When should desensitization be initiated for penicillin?

A

Regardless of the allergen test report

This is due to the poor sensitivity of allergen tests.

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5
Q

What is a significant risk associated with relying on a single allergen test report?

A

The risk of anaphylaxis

This emphasizes the need for caution in allergy assessments.

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6
Q

Fill in the blank: Allergy evaluation should be conducted in patients with any history suggesting an _______.

A

allergy

This underlines the importance of thorough patient histories.

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7
Q

What is the most common trigger of bacteremia leading to IE?

A

Dental procedures, surgery, distant primary infections, and nonsterile injections

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8
Q

What are the two types of infective endocarditis based on the speed of development?

A

Acute and subacute

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9
Q

What organism is usually responsible for acute bacterial endocarditis?

A

Staphylococcus aureus

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10
Q

What is the typical cause of subacute bacterial endocarditis?

A

Viridans streptococci

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11
Q

Who is most commonly affected by subacute bacterial endocarditis?

A

Individuals with preexisting damage to heart valves, congenital heart defects, and/or prosthetic valves

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12
Q

List some clinical features of infective endocarditis.

A
  • Fatigue
  • Fever
  • Chills
  • Malaise
  • New or changed heart murmur
  • Signs of heart failure
  • Manifestations of organ damage (e.g., glomerulonephritis, septic embolic stroke)
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13
Q

What are the 2023 Duke-ISCVID criteria used for?

A

To assess the likelihood of infective endocarditis

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14
Q

What is the initial treatment for infective endocarditis?

A

Empiric IV antibiotics, adjusted based on blood culture results

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15
Q

Why is distinguishing between native and prosthetic valve IE important?

A

It allows for more tailored treatment

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16
Q

When may surgery be necessary in cases of infective endocarditis?

A

In complex cases such as valve perforation

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17
Q

Is prophylaxis for infective endocarditis recommended?

A

Yes, in specific circumstances like congenital heart disease during certain dental procedures

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18
Q

True or False: Infective endocarditis is typically non-fatal if left untreated.

A

False

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19
Q

What is indicated prior to certain procedures with a high risk of bacteremia in patients with high-risk cardiac features?

A

Prophylaxis

Prophylaxis is important to prevent infective endocarditis (IE) in susceptible patients

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20
Q

List the cardiac risk factors requiring infective endocarditis prophylaxis.

A
  • Presence of prosthetic cardiac valve or material
  • History of endocarditis
  • Certain types of congenital heart disease (CHD)
  • Valvulopathy in cardiac transplant recipients

Specific CHD types include unrepaired cyanotic CHD, repaired CHD within 6 months of repair, and repaired CHD with residual post-operative shunt or regurgitation

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21
Q

What are some procedures that require infective endocarditis prophylaxis in patients at risk?

A
  • Dental procedures including tooth extraction and routine dental cleaning
  • Invasive procedures involving respiratory tract or infected tissue
  • Placement of a CIED
  • Surgical placement of prosthetic cardiac or intravascular material

CIED stands for cardiac implantable electronic device

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22
Q

What is the common prophylaxis regimen for patients without a penicillin allergy prior to dental procedures?

A
  • Amoxicillin
  • Ampicillin
  • Cefazolin

The specific dosage is not provided in the text

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23
Q

What is the recommended prophylaxis regimen for patients with a penicillin allergy prior to dental procedures?

A
  • Macrolide (e.g., azithromycin)
  • Doxycycline

The specific dosage for these medications is not provided in the text

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24
Q

What is the recommended prophylaxis regimen prior to CIED placement?

A

Cefazolin

The specific dosage is not provided in the text

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25
Q

True or False: Infective endocarditis prophylaxis is routinely recommended prior to nondental procedures.

A

False

IE prophylaxis is not routinely recommended unless infected tissue is present

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26
Q

Fill in the blank: Pathogen-specific agents may be indicated depending on the _______.

A

[site of the procedure]

This indicates that the choice of prophylactic agent can vary based on the type of procedure being performed

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27
Q

What is schistosomiasis?

A

A parasitic disease caused by schistosomes, a type of trematode

Schistosomiasis is transmitted through contact with parasite-infested water.

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28
Q

How does infection occur in schistosomiasis?

A

When skin comes into contact with parasite-infested water

This typically happens in freshwater bodies where schistosomes are present.

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29
Q

What is swimmer’s itch?

A

A pruritic maculopapular rash caused by initial skin penetration by schistosomes

This rash is an early manifestation of schistosomiasis.

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30
Q

What is acute schistosomiasis syndrome also known as?

A

Katayama fever

This syndrome occurs during parasite migration through the bloodstream.

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31
Q

What are the symptoms of acute schistosomiasis syndrome?

A
  • Fever
  • Cough
  • Angioedema

These symptoms reflect an acute inflammatory response to the parasites.

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32
Q

What does chronic infection by schistosomes cause?

A

A granulomatous inflammatory response to schistosome eggs

The severity and symptoms vary based on the location of the infection.

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33
Q

What are the manifestations of genitourinary schistosomiasis?

A
  • Hematuria
  • Dysuria

Long-standing infection increases the risk of bladder cancer.

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34
Q

What are the symptoms of intestinal schistosomiasis?

A
  • Diarrhea
  • Abdominal pain

Symptoms can vary based on the severity of the infection.

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35
Q

What can hepatosplenic schistosomiasis lead to?

A
  • Hepatosplenomegaly
  • Portal hypertension

These conditions result from chronic schistosomiasis affecting the liver and spleen.

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36
Q

How is schistosomiasis diagnosed?

A

By identifying eggs on microscopic examination of stool or urine

This is the primary method for confirming the presence of schistosomes.

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37
Q

What is the treatment for acute schistosomiasis syndrome?

A

Symptomatic treatment with glucocorticoids

Glucocorticoids help manage the inflammatory response.

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38
Q

What is the mainstay of treatment for parasite eradication in schistosomiasis?

A

Praziquantel

Praziquantel is effective against all forms of schistosomiasis.

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39
Q

What is infectious gastroenteritis?

A

An inflammation of the gastrointestinal tract caused by various pathogens.

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40
Q

What are the most common viral causes of infectious gastroenteritis?

A

Norovirus, rotavirus, enteric adenovirus.

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41
Q

Name some bacterial causes of infectious gastroenteritis.

A
  • Campylobacter
  • Salmonella
  • Shigella
  • Yersinia
  • Vibrio cholerae
  • Diarrheagenic Escherichia coli
  • Clostridioides difficile
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42
Q

What types of pathogens can cause infectious gastroenteritis?

A
  • Viruses
  • Bacteria
  • Fungi
  • Parasites (protozoans, helminths)
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43
Q

What are common transmission routes for infectious gastroenteritis?

A
  • Fecal-oral
  • Foodborne
  • Waterborne
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44
Q

What is crucial for preventing infectious gastroenteritis?

A

Education on food and water hygiene.

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45
Q

List some clinical features of mild infectious gastroenteritis.

A
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting
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46
Q

What are some severe clinical features of infectious gastroenteritis?

A
  • Sepsis
  • Intense abdominal pain
  • Significant dehydration from severe diarrhea and/or vomiting
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47
Q

In cases of mild gastroenteritis, what is usually required?

A

Supportive therapy, such as oral rehydration and antiemetics.

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48
Q

When might stool cultures and empiric antibiotic therapy be considered?

A

In patients with severe gastroenteritis and/or risk factors for complicated disease.

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49
Q

True or False: Infectious gastroenteritis is always severe and requires hospitalization.

A

False

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50
Q

Fill in the blank: The fecal-oral route is a common transmission method for _______ gastroenteritis.

A

[infectious]

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51
Q

What is the typical course of infectious gastroenteritis?

A

Usually self-limiting.

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52
Q

What additional topics are covered separately regarding infectious gastroenteritis?

A

Infectious gastroenteritis in children and Clostridioides difficile infection.

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53
Q

What is anthrax?

A

A rare infectious disease caused by Bacillus anthracis.

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54
Q

What type of bacterium causes anthrax?

A

Gram-positive spore-forming bacterium.

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55
Q

Where is Bacillus anthracis typically found?

A

In soil.

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56
Q

How do humans usually become infected with anthrax?

A

Contact with infected livestock or infected animal products.

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57
Q

What are examples of infected animal products that can transmit anthrax?

A
  • Wool
  • Meat
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58
Q

What are the three distinct clinical syndromes of anthrax based on the route of entry?

A
  • Inhalation anthrax
  • Cutaneous anthrax
  • Gastrointestinal anthrax
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59
Q

Which form of anthrax is the most common?

A

Cutaneous anthrax.

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60
Q

What is the initial presentation of cutaneous anthrax?

A

A papular lesion.

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61
Q

What does the papular lesion of cutaneous anthrax eventually become?

A

A necrotic eschar.

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62
Q

What are the symptoms of inhalation anthrax?

A
  • Fever
  • Acute, nonproductive cough
  • Retrosternal chest pain
  • Pleural effusion
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63
Q

What severe condition does inhalation anthrax result in?

A

Hemorrhagic mediastinitis.

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64
Q

What symptoms are associated with gastrointestinal anthrax?

A
  • Gastrointestinal ulceration
  • Hematemesis
  • Bloody diarrhea
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65
Q

Is gastrointestinal anthrax common?

A

No, it is very rare.

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66
Q

How is the diagnosis of anthrax confirmed?

A

Microscopic evidence of B. anthracis.

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67
Q

What is the mortality rate of anthrax without treatment?

A

High.

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68
Q

What types of antibiotics can increase survival in anthrax patients?

A
  • Fluoroquinolones
  • Linezolid (oxazolidinonas)
  • Meropenem (betalactam)
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69
Q

Which form of anthrax has a better prognosis, cutaneous or inhalation?

A

Cutaneous anthrax.

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70
Q

Fill in the blank: Anthrax can be weaponized for _______.

A

[biological warfare/terrorism]

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71
Q

True or False: Cutaneous anthrax is the least common form of anthrax.

A

False.

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72
Q

What is schistosomiasis?

A

A parasitic disease caused by schistosomes, a type of trematode.

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73
Q

How does infection with schistosomiasis occur?

A

When skin comes into contact with parasite-infested water.

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74
Q

What is the initial skin reaction to schistosomiasis infection called?

A

Swimmer’s itch.

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75
Q

What are the clinical manifestations of acute schistosomiasis syndrome?

A

Fever, cough, and angioedema.

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76
Q

What is another name for acute schistosomiasis syndrome?

A

Katayama fever.

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77
Q

What type of inflammatory response is caused by chronic schistosomiasis?

A

Granulomatous inflammatory response to schistosome eggs.

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78
Q

What symptoms are associated with genitourinary schistosomiasis?

A

Hematuria and dysuria.

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79
Q

What long-term risk is associated with genitourinary schistosomiasis?

A

Increased risk of bladder cancer.

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80
Q

What symptoms may indicate intestinal schistosomiasis?

A

Diarrhea and abdominal pain.

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81
Q

What complications can arise from hepatosplenic schistosomiasis?

A

Hepatosplenomegaly and/or portal hypertension.

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82
Q

How is schistosomiasis diagnosed?

A

By identifying eggs on microscopic examination of stool or urine.

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83
Q

What is the treatment for acute schistosomiasis syndrome?

A

Symptomatic treatment with glucocorticoids.

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84
Q

What is the mainstay of treatment for parasite eradication in schistosomiasis?

A

Praziquantel.

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85
Q

What is the most likely diagnosis in a patient with recent antibiotic use, watery diarrhea, fever, and leukocytosis with left shift?

A

Clostridioides difficile infection

Symptoms of C. difficile infection typically begin during or within 21 days of an antibiotic course.

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86
Q

What antibiotic is a known causative agent of C. difficile infection?

A

Clindamycin

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87
Q

What is the recommended first-line agent for the treatment of an initial episode of severe C. difficile infection?

A

Vancomycin

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88
Q

Under what conditions is C. difficile disease considered severe?

A

If the patient has systemic toxicity, a peripheral leukocyte count >14,000 per mm3, or a high-risk condition

High-risk conditions include renal insufficiency and intensive care status.

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89
Q

What alternative antibiotic may be considered for less severe cases of C. difficile infection?

A

Metronidazole

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90
Q

What new antibiotic is recommended as first-line therapy for adults (≥18 years) with C. difficile infection?

A

Fidaxomicin (macrolido)

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91
Q

When is fidaxomicin recommended for children?

A

In the setting of multiple recurrent infections

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92
Q

What key learning point is associated with pediatric patients and recent antibiotic use?

A

The onset of watery diarrhea, fever, and leukocytosis is concerning for Clostridioides difficile colitis, and empiric therapy with vancomycin should be initiated.

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93
Q

What is the recommended age range for receiving the HPV vaccine?

A

11–26 years of age

The HPV vaccine is recommended for all unvaccinated individuals within this age range.

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94
Q

Why should this patient be offered the HPV vaccine?

A

He does not have any documentation of having received it

Documentation of previous vaccination is necessary to determine if a patient should receive the vaccine.

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95
Q

What should all mothers with HIV be counseled about?

A

The risks of HIV transmission through breast milk

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96
Q

In resource-rich areas, what should women breastfeeding with incompletely suppressed viral loads or low CD4-cell counts be counseled to do?

A

Avoid breastfeeding

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97
Q

What type of counseling should clinicians engage in regarding infant feeding?

A

Evidence-based counseling to support shared decision-making

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98
Q

What is the risk of HIV transmission through breastfeeding for women with virologic suppression during pregnancy?

A

Low (<1%) risk

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99
Q

What should women who want to eliminate the risk of HIV transmission completely be counseled to use for infant feeding?

A

Formula or donor milk from a milk bank

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100
Q

In low-resource areas, what is recommended for breastfeeding mothers with HIV?

A

Combination antiretroviral therapy

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101
Q

What should infants of breastfeeding mothers with HIV receive in low-resource areas?

A

A 6-week course of nevirapine

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102
Q

What outweighs the potential adverse effects of antiretroviral medications in breast milk in low-resource areas?

A

The benefits of breast milk in the absence of a safe water supply

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103
Q

What maternal viral load indicates a high risk for perinatal HIV transmission?

A

> 1000 copies

104
Q

What other infectious contraindications to breastfeeding exist?

A

Maternal human T-cell lymphotropic virus type 1 or 2, untreated brucellosis, active untreated tuberculosis, infected lesions on the breast

105
Q

When can women with active tuberculosis resume breastfeeding?

A

After being treated for at least 2 weeks and are no longer infectious

106
Q

Fill in the blank: In areas where infant formula is accessible, affordable, and free, women with HIV should be counseled to _______ if their CD4-cell count is low.

A

avoid breastfeeding

107
Q

True or False: The risk of HIV transmission through breastfeeding is zero for women with virologic suppression.

108
Q

What is the most common cause of acute community-acquired bloody diarrhea in febrile patients?

A

Enteric infections such as Salmonella, Shigella, Campylobacter, or Shiga toxin-producing Escherichia coli (STEC)

These pathogens are often responsible for bloody diarrhea in febrile patients.

109
Q

Why is it important to correctly diagnose infection with STEC?

A

For public health reasons and because antibiotic treatment may increase the risk for hemolytic-uremic syndrome

Hemolytic-uremic syndrome is a serious complication associated with STEC infections.

110
Q

What type of test should be used to identify STEC in stool samples?

A

An enzyme immunoassay for Shiga toxin

This method is preferred because stool culture cannot identify non-O157 strains.

111
Q

What percentage of STEC infections are accounted for by non-O157 strains?

A

About 40%

Non-O157 strains are significant contributors to STEC infections.

112
Q

What should be included in the evaluation of acute community-acquired bloody diarrhea in a patient with no history of antibiotic exposure?

A

Both a stool culture for enteric pathogens and a non-culture-based immunoassay for Shiga toxin

This dual approach ensures a comprehensive evaluation of potential pathogens.

113
Q

What is the Mycobacterium avium complex known for?

A

It is the most frequent cause of pulmonary infection due to nontuberculous mycobacteria in the United States.

Mycobacterium avium complex is ubiquitous in the environment.

114
Q

Who are the typical patients with isolated pulmonary M. avium complex?

A

Immunocompetent adults, most commonly with underlying lung disease, or postmenopausal women.

These patients often present with specific symptoms and imaging findings.

115
Q

What symptoms do patients with M. avium complex typically present with?

A

Chronic cough, fever, and weight loss.

These symptoms can indicate a pulmonary infection.

116
Q

What imaging findings are associated with Mycobacterium avium complex infection in postmenopausal women?

A

Nodular opacities with bronchiectasis in the right middle lobe.

This presentation is also referred to as Lady Windermere syndrome.

117
Q

What do sputum cultures show in cases of M. avium complex infection?

A

Acid-fast bacilli.

This finding is typical for infections caused by mycobacteria.

118
Q

Fill in the blank: The most likely cause of chronic cough, fever, and weight loss in an older woman with bronchiectasis and nodular opacities on chest imaging is _______.

A

Mycobacterium avium complex infection.

119
Q

What does hydrogen peroxide oxidize?

A

Cell membrane lipids, intracellular proteins, and DNA

Hydrogen peroxide oxidizes these components by forming hydroxyl free radicals.

120
Q

What are the uses of hydrogen peroxide?

A

Wound disinfection and surface disinfectant

It is commonly used in medical settings and for cleaning purposes.

121
Q

Hydrogen peroxide is active against which types of microorganisms?

A

Bacteria, yeasts, fungi, viruses, and spores

This broad spectrum of activity makes it effective for various disinfection purposes.

122
Q

True or False: Hydrogen peroxide is only effective against bacteria.

A

False

Hydrogen peroxide is effective against multiple types of microorganisms.

123
Q

Fill in the blank: Hydrogen peroxide forms _______ free radicals during oxidation.

A

hydroxyl

These free radicals are highly reactive and contribute to the oxidative damage.

124
Q

What are noninfectious complications related to HIV?

A

Chronic inflammation from HIV or adverse effects of antiretroviral therapy

Noninfectious complications can arise from the body’s response to HIV or the medications used to treat it.

125
Q

What are some complications of antiretroviral therapy?

A
  • Dyslipidemia
  • Impaired glucose tolerance
  • Osteoporosis

These complications can affect metabolic health and bone density in patients undergoing treatment.

126
Q

What is the effect of all antiretroviral regimens on bone mineral density (BMD)?

A

All antiretroviral regimens contribute to a loss of BMD

This loss varies among different regimens, with some having a more pronounced effect.

127
Q

Which antiretroviral regimen is associated with a greater decline in BMD?

A

Tenofovir disoproxil fumarate

This specific formulation has been linked to more significant bone density loss compared to others.

128
Q

How does tenofovir alafenamide compare to tenofovir disoproxil fumarate regarding BMD?

A

Tenofovir alafenamide has less effect on BMD than tenofovir disoproxil fumarate

This suggests it may be a preferable option for preserving bone density.

129
Q

Who should be screened for osteoporosis according to current guidelines?

A
  • Men aged 50 or older
  • Postmenopausal women of any age
  • People with a fragility-type fracture

These groups are at higher risk for osteoporosis and should undergo screening.

130
Q

What key learning point is associated with tenofovir disoproxil fumarate use in people with HIV?

A

It has been associated with both renal disease and osteoporosis

This highlights the importance of monitoring kidney function and bone health in patients receiving this medication.

131
Q

What is critical to obtain in any patient with a possible endovascular focus of infection?

A

At least two sets of blood cultures

This is crucial before initiating antimicrobial therapy.

132
Q

Who should be consulted for the complete removal of an infected device?

A

A specialist in electrophysiology

This is recommended to definitively cure the infection and prevent relapse.

133
Q

What is recommended as initial empiric therapy due to oxacillin resistance among isolates?

A

Vancomycin

This is particularly important for infections near the site of an implanted cardiac electronic device.

134
Q

When should treatment be started in patients with suspected infections?

A

After blood cultures are obtained

This ensures accurate diagnosis before commencing therapy.

135
Q

What is an essential initial step in evaluating a patient with suspected implanted cardiac-pacemaker infection?

A

Draw at least two blood cultures

This is particularly important if there are no stigmata of infective endocarditis.

136
Q

What should be done with invasive devices, especially central venous catheters, postoperatively?

A

They should be removed as soon as possible to minimize the risk for device-associated infections.

Central venous catheters are particularly high-risk devices for infections.

137
Q

What is the recommended action for a patient with fever and positive blood cultures?

A

Remove the central venous catheter and start intravenous antibiotics while awaiting final blood culture results.

Prompt action is crucial to manage potential infections effectively.

138
Q

What is a common cause of postoperative fever within the first 48 hours?

A

Cytokine release, transfusion reaction, or drug hypersensitivity.

These causes are typically non-infectious.

139
Q

Which infections are common within the first week after surgery?

A

Pneumonia and infections associated with central venous or urinary catheters.

Early postoperative infections can significantly impact recovery.

140
Q

When do surgical-site infections typically occur after surgery?

A

More than a week after surgery.

This timing is critical for diagnosing and managing infections.

141
Q

What are late-onset complications that can arise after surgery?

A

Infection with Clostridioides difficile, venous thromboembolism, and late-onset central venous catheter-associated infections.

These complications may require different management strategies.

142
Q

Fill in the blank: Postoperative fever is common, and its etiology varies with the time since the operation, with immediate fever usually due to _______.

A

cytokine release, transfusion reaction, or drug hypersensitivity.

143
Q

True or False: It is unnecessary to remove central venous catheters in patients with fever and positive blood cultures.

A

False.

Immediate removal is essential to prevent further complications.

144
Q

What is indicative of infection with Neisseria meningitidis?

A

The finding of gram-negative intracellular diplococci in a patient with clinical features of bacterial meningitis

This finding is crucial for diagnosing bacterial meningitis caused by N. meningitidis.

145
Q

What factors have contributed to the decreasing incidence of N. meningitidis infections?

A

Routine use of meningococcal vaccine

The vaccination program has significantly reduced the occurrence of these infections.

146
Q

What are the common transmission environments for N. meningitidis?

A

Close quarters such as summer camps and college dormitories

These environments facilitate the spread of the bacteria through aerosolized oral secretions.

147
Q

Who should receive postexposure chemoprophylaxis for N. meningitidis infection?

A

Individuals exposed to patients with known or presumed infection, including:
* Those who have had contact with the patient’s oral or respiratory secretions
* Household members, day-care contacts, and those close to the patient
* Travelers sitting next to the index patient on long flights

Close contact increases the risk of transmission and necessitates prophylaxis.

148
Q

What is the first-line chemoprophylaxis for adults exposed to N. meningitidis?

A

Oral rifampin, oral ciprofloxacin, or parenteral ceftriaxone

Each agent is effective in eliminating nasopharyngeal carriage of the bacteria.

149
Q

What is the effectiveness rate of the first-line chemoprophylaxis agents for N. meningitidis?

A

90% to 95% effective

These agents are highly effective in preventing the spread of infection.

150
Q

What is the ideal timing for initiating rifampin after exposure to N. meningitidis?

A

Within 24 hours after exposure

Timely administration is crucial for effectiveness.

151
Q

What is the appropriate dosing regimen for rifampin after exposure?

A

10 mg/kg (maximum 600 mg) every 12 hours for 2 days

Proper dosing is essential for achieving effective prophylaxis.

152
Q

How is ciprofloxacin or ceftriaxone administered after exposure to N. meningitidis?

A

As a single dose following exposure

This method simplifies the treatment regimen.

153
Q

What are the most effective measures for the prevention of catheter-associated urinary tract infections (UTIs)?

A

Avoidance of unnecessary catheterization, sterile technique during catheter placement, early removal of urinary catheters

These measures are crucial for reducing the risk of UTIs in patients with catheters.

154
Q

When should catheters be removed for patients undergoing surgery not involving the urinary tract?

A

As soon as possible, preferably within 24 hours postoperatively

Timely removal of catheters is essential to minimize infection risk.

155
Q

Fill in the blank: The early removal of urinary catheters is recommended when they are no longer _______.

A

indicated

This practice helps prevent infections.

156
Q

True or False: Sterile technique during catheter placement is a recommended measure for preventing catheter-associated UTIs.

A

True

Using a sterile technique is vital for infection control.

157
Q

What is the common cause of fever in children?

A

Self-limited viral illness or signs and symptoms consistent with a bacterial illness

158
Q

What key history elements should be included when evaluating a child with fever?

A

Onset, duration, height of fever, associated symptoms, irritability or lethargy, known sick contacts, medical history, immunization status, travel history

159
Q

What is the goal in evaluating a patient with fever?

A

To rule out an occult bacterial source of infection

160
Q

Name some occult bacterial sources of infection to consider in a febrile child.

A
  • Acute otitis media
  • Urinary tract infection
  • Bacteremia
  • Meningitis
  • Osteomyelitis
161
Q

What should be performed alongside a thorough history in evaluating fever?

A

A thorough physical examination and supporting laboratory tests

162
Q

What conditions should be considered in a young child with fever and rash?

A
  • Viral illness
  • Kawasaki disease
163
Q

What makes Kawasaki disease less likely in a patient with fever and rash?

A

Fever resolving after 4 days

164
Q

What is the classic presentation of human herpesvirus 6 (HHV-6) infection?

A

High fevers (>39.5°C) for 3 to 5 days followed by pink noncoalescent macules on the trunk, face, and proximal extremities

165
Q

What is another name for human herpesvirus 6 infection?

A

Roseola infantum or exanthem subitum

166
Q

When do patients with HHV-6 generally appear well?

A

When the rash appears

167
Q

What lymphadenopathy may be noted on examination in patients with roseola?

A

Postoccipital lymphadenopathy

168
Q

What percentage of children with primary HHV-6 infection experience febrile seizures?

A

Approximately 10% to 15%

169
Q

What is the most common cause of arboviral-acquired disease in the US?

A

West Nile virus (WNV)

WNV is the leading cause of such diseases in the United States.

170
Q

What percentage of WNV infections are asymptomatic?

A

Approximately 80%

Most patients do not exhibit symptoms.

171
Q

What is West Nile fever?

A

A self-limiting disease that typically lasts 3–10 days and manifests with fever, headaches, and a transient maculopapular rash

Symptoms appear on the trunks and extremities.

172
Q

What are the symptoms of West Nile fever?

A

Fever, headaches, and a transient maculopapular rash

The rash is typically seen on the trunks and extremities.

173
Q

What is the risk of neuroinvasive disease from WNV infection?

A

Up to 1% of patients

This includes severe manifestations such as meningitis and encephalitis.

174
Q

What are the manifestations of neuroinvasive disease caused by WNV?

A

Fever and meningitis, encephalitis, or acute flaccid paralysis

These are serious complications of WNV infection.

175
Q

What are the risk factors for neuroinvasive disease from WNV?

A

Age > 60 years, immunosuppression, comorbidities (e.g., hypertension, diabetes mellitus)

These factors increase the likelihood of severe disease.

176
Q

What is the usual treatment for WNV infection?

A

Supportive treatment

The condition is typically self-limiting.

177
Q

True or False: Most WNV infections lead to severe neurological illness.

A

False

Most infections are asymptomatic or result in mild illness.

178
Q

Fill in the blank: WNV infection can lead to a _______ disease that manifests with fever and neurological symptoms.

A

neuroinvasive

This includes serious conditions such as meningitis and encephalitis.

179
Q

How long does West Nile fever typically last?

A

3–10 days

It is a self-limiting condition.

180
Q

What are the initial symptoms of disseminated gonococcal infection?

A

Fever, chills, malaise

These symptoms typically precede more specific manifestations.

181
Q

What are the main presentations after fever resolves in disseminated gonococcal infection?

A

Triad of tenosynovitis, dermatitis, polyarthralgias or frank arthritis

Overlap in these presentations is frequent.

182
Q

What does tenosynovitis generally affect?

A

Multiple tendons at once

This condition is characterized by inflammation of the tendon sheath.

183
Q

How does dermatitis present in disseminated gonococcal infection?

A

Transient pustular or vesicular skin lesions

These skin manifestations are typically few in number.

184
Q

What happens to patients who initially present with the triad without treatment?

A

Progress to joint involvement

Joint involvement is a common progression in untreated cases.

185
Q

Which joints are most commonly affected by arthritis in disseminated gonococcal infection?

A

Knees, wrists, ankles

This can occur in a monoarticular or asymmetric polyarticular fashion.

186
Q

What is the typical method for diagnosing disseminated gonococcal infection?

A

Positive blood or synovial fluid culture for Neisseria gonorrhoeae

These cultures are only positive in about 50% of cases.

187
Q

What other cultures or tests are important for diagnosing disseminated gonococcal infection?

A

Vaginal, rectal, pharyngeal cultures, or nucleic acid amplification tests (NAATs)

These tests can be positive in 50% to 80% of patients, even if asymptomatic.

188
Q

Why is testing local sites critical for diagnosis in disseminated gonococcal infection?

A

Synovial fluid Gram stain may be negative

Testing local sites helps confirm diagnosis when other tests are inconclusive.

189
Q

What should synovial fluid be examined for in suspected cases of disseminated gonococcal infection?

A

N. gonorrhoeae by NAAT

NAAT can provide a more sensitive detection method for this pathogen.

190
Q

What is a limitation of serological studies for syphilis?

A

They can miss early primary syphilis, as antibodies do not develop until 1–4 weeks after lesions appear.

Antibodies may not be detectable immediately after infection.

191
Q

What testing algorithms are used to confirm a syphilis diagnosis?

A

Syphilis testing algorithms combine nontreponemal and treponemal tests.

These algorithms enhance diagnostic accuracy.

192
Q

What clinical factors should be considered when interpreting syphilis test results?

A

Clinical features, risk factors, treatment history.

Context is crucial for accurate interpretation.

193
Q

What is a key consideration regarding serologic testing in previously treated syphilis patients?

A

Serologic testing may remain positive.

This can complicate the interpretation of current infections.

194
Q

What are the indications for nontreponemal tests (NTT)?

A
  • Initial screening
  • Monitoring response to treatment
  • Assessing for syphilis reinfection

NTTs are valuable for both diagnosis and management.

195
Q

What is the mechanism of nontreponemal tests (NTT)?

A

Quantitative detection of antibodies against lipoidal antigens, e.g., cardiolipin.

This reflects an immune response to syphilis.

196
Q

What are the most commonly used nontreponemal tests?

A
  • Rapid plasma reagin (RPR)
  • Venereal Disease Research Laboratory test (VDRL)

RPR is the most widely used, while VDRL is often used for neurosyphilis.

197
Q

What is the accuracy of nontreponemal tests in detecting primary syphilis?

A

Highly sensitive but nonspecific; positive in ∼ 62–78% of patients with primary syphilis.

This indicates variability in test performance.

198
Q

What are potential causes of false-negative results in nontreponemal tests?

A
  • Early primary syphilis
  • Prozone phenomenon
  • Longstanding untreated syphilis with seroreversion

These factors can obscure true infection status.

199
Q

What are potential causes of false-positive results in nontreponemal tests?

A
  • Autoimmune diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis)
  • Infections (e.g., malaria, leprosy, Epstein-Barr virus, viral hepatitis)
  • Rheumatic fever
  • Pregnancy
  • Prescription drugs (e.g., chlorpromazine, procainamide)
  • Intravenous drug use

False positives can arise from various non-syphilitic conditions.

200
Q

What happens to nontreponemal test (NTT) titers after infection?

A

NTT titers can undergo seroreversion and convert to negative even if syphilis is not treated.

This complicates the monitoring of treatment success.

201
Q

What is the mechanism of treponemal tests (TT)?

A

Qualitative detection of antibodies to treponemal antigens.

TTs are specific for Treponema pallidum.

202
Q

What are the indications for treponemal tests (TT)?

A
  • Initial screening
  • Confirmatory test in the standard testing algorithm

TTs provide definitive evidence of infection.

203
Q

What are common types of treponemal tests?

A
  • Fluorescent treponemal antibody absorption test (FTA-ABS)
  • Treponema pallidum particle agglutination (TPPA)
  • IgG/IgM immunoassay (enzyme or chemiluminescence)

These tests vary in methodology but serve similar diagnostic purposes.

204
Q

What is the accuracy of treponemal tests in new infections?

A

High sensitivity and specificity.

TTs are reliable for confirming recent infections.

205
Q

What are potential causes of false-negative results in treponemal tests?

A

Early primary syphilis.

Timing of testing is critical for accurate results.

206
Q

What are potential causes of false-positive results in treponemal tests?

A
  • Inflammatory diseases (e.g., systemic lupus erythematosus)
  • Infections (e.g., Lyme disease)

Similar to NTTs, TT results can be influenced by other conditions.

207
Q

What happens to treponemal test (TT) titers after infection?

A

TT titer typically stays positive indefinitely.

This characteristic is important for historical infection tracking.

208
Q

What is Kaposi sarcoma (KS) typically associated with?

A

HIV infection

209
Q

In patients with HIV, KS typically occurs with a CD4 count of less than _______.

A

<150 cells/mm3

210
Q

What is the reference range for CD4 count?

A

400–1600 cells/mm3

211
Q

What viral load is associated with the occurrence of KS in HIV patients?

A

> 10,000 copies/mL

212
Q

True or False: HIV-associated KS can occur in patients with high CD4-cell count and low viral load.

213
Q

KS has been reported in patients on long-term _______ therapy.

A

antiretroviral

214
Q

What is Trimethoprim-sulfamethoxazole (TMP-SMX) used for in VIH patients?

A

Prophylaxis for Pneumocystis jirovecii pneumonia (PCP) and toxoplasmosis in HIV patients

215
Q

In patients with HIV and a CD4+ count < 200/mm3, TMP-SMX is used to prevent which condition?

A

Pneumocystis jirovecii pneumonia (PCP)

216
Q

In patients with HIV and a CD4+ count < 100/mm3, TMP-SMX is used to prevent which condition?

A

Toxoplasmosis

217
Q

What alternatives can be administered to patients allergic to TMP-SMX?

A

Oral dapsone or atovaquone

218
Q

What may be used if none of the other prophylactic agents are available?

A

Aerosolized pentamidine

219
Q

Fill in the blank: TMP-SMX is used as prophylaxis for Pneumocystis jirovecii pneumonia (PCP) in patients with HIV and a CD4+ count < _______.

220
Q

Fill in the blank: TMP-SMX is used as prophylaxis for toxoplasmosis in patients with HIV and a CD4+ count < _______.

221
Q

True or False: TMP-SMX is the only option for prophylaxis in HIV patients.

222
Q

What is the treatment recommendation for patients with chronic hepatitis B virus infection who test negative for hepatitis B e antigen?

A

Treatment is recommended if the HBV viral load is greater than 2000 IU/mL and the alanine aminotransferase level is greater than twice the upper limit of normal.

223
Q

What are the criteria for a chronic hepatitis B virus patient to be a candidate for treatment?

A

HBV viral load greater than 2000 IU/mL and alanine aminotransferase level greater than twice the upper limit of normal.

224
Q

What are the first-line oral antiviral therapies for chronic HBV infection?

A

Tenofovir or entecavir.

225
Q

Fill in the blank: First-line antiviral therapy for chronic hepatitis B virus infection consists of either _______ or _______.

A

tenofovir or entecavir.

226
Q

True or False: Entecavir is a first-line treatment for chronic hepatitis B virus infection.

227
Q

What is the significance of alanine aminotransferase levels in assessing treatment candidacy for chronic hepatitis B?

A

Levels must be greater than twice the upper limit of normal.

228
Q

What is considered a high HBV viral load in the context of treatment candidacy?

A

Greater than 2000 IU/mL.

229
Q

What does PPSV23 stand for?

A

Pneumococcal polysaccharide vaccine

230
Q

What type of bacteria does PPSV23 protect against?

A

Streptococcus pneumonia

231
Q

What is the most common cause of sepsis in children with sickle cell disease?

A

Streptococcus pneumonia

232
Q

What condition do children with sickle cell disease develop due to recurrent splenic infarction?

A

Functional asplenia

233
Q

At what age do children with sickle cell disease typically develop functional asplenia?

A

By the age of 4

234
Q

Why are children with sickle cell disease at increased risk of infection?

A

Due to functional asplenia and increased risk of infection with encapsulated organisms

235
Q

Fill in the blank: The pneumococcal polysaccharide vaccine prevents infection with _______.

A

Streptococcus pneumonia

236
Q

True or False: Functional asplenia increases the risk of infection with encapsulated organisms.

237
Q

What are the initial symptoms of Bordetella pertussis infection?

A

Malaise, rhinorrhea, and cough

This phase is known as the catarrhal phase.

238
Q

What characterizes the paroxysmal phase of Bordetella pertussis infection?

A

Severe paroxysms of a dry cough

This phase follows the initial symptoms.

239
Q

What is the recommended time frame for treatment initiation after cough onset for patients older than 1 year?

A

Within 3 weeks

This recommendation is made by the Centers for Disease Control and Prevention.

240
Q

What effect does antibiotic therapy have on Bordetella pertussis transmission?

A

Decreases further transmission

However, it may not improve the duration or severity of symptoms if started later.

241
Q

What is the treatment of choice for Bordetella pertussis infection?

A

A 5–7-day course of a macrolide antibiotic

Examples include azithromycin or clarithromycin.

242
Q

How long should erythromycin be administered for Bordetella pertussis infection?

A

14 days

Erythromycin is an acceptable alternative to macrolides.

243
Q

True or False: A patient with a history of cough paroxysms suspected to have B. pertussis infection should receive treatment with a macrolide antibiotic.

A

True

This is a key learning point regarding treatment.

244
Q

What should be performed for any patient that meets the suspected case definition for pertussis?

A

Confirmatory studies

This includes various diagnostic tests based on the duration since symptom onset.

245
Q

What are the preferred diagnostic tests for pertussis in the first 1-4 weeks since symptom onset?

A

PCR ± culture

These tests are recommended to confirm a suspected case of pertussis.

246
Q

What diagnostic test should be considered between 4-12 weeks since cough onset?

A

Serum sample for serology

This is appropriate for cases that are beyond the acute phase.

247
Q

What is a common finding in infants and young children with pertussis?

A

Lymphocyte-predominant leukocytosis

An absolute lymphocyte count of > 20,000 cells/μL suggests a poor prognosis.

248
Q

What are the symptoms that indicate a suspected case of pertussis?

A

Cough with ≥ 1 of the following:
* Paroxysmal coughing
* Whooping on inspiration
* Posttussive vomiting
* Apnea

Additional factors include known contact with a confirmed case or living in an outbreak area.

249
Q

What does the presence of fever suggest in a patient suspected of having pertussis?

A

An alternative diagnosis

Fever is not a typical symptom of pertussis.

250
Q

What is the preferred test for diagnosing pertussis?

A

PCR

It has high sensitivity and rapid results, unaffected by antibiotic therapy or previous vaccination.

251
Q

What specimen collection method is preferred for PCR testing in suspected pertussis cases?

A

Nasopharyngeal swab

An alternative method is saline nasopharyngeal aspirate.

252
Q

What is considered the gold standard for pertussis diagnosis?

A

Bacterial culture

It has 100% specificity but is limited by long growth time and low sensitivity.

253
Q

What are the indications for using bacterial culture in pertussis diagnosis?

A

Alternative when PCR is not available and for strain identification

It is used in addition to PCR.

254
Q

What criteria must be met for serology testing in suspected pertussis cases?

A

4-12 weeks since cough onset, age ≥ 6 months, ≥ 1 year since last vaccination

Findings include increased IgG antibodies to pertussis toxin.

255
Q

What does the CDC accept for disease reporting in pertussis cases?

A

Positive culture or PCR

Serology is suggested for use in outbreak settings but not accepted for reporting.

256
Q

True or False: Direct fluorescent antibody testing and blood cultures are recommended for pertussis diagnosis.

A

False

These methods are not recommended due to low specificity and sensitivity.

MEDICINA (9 decks)

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